Shoulder Hemiarthroplasty With Nonprosthetic Glenoid Arthroplasty: The Ream and Run

Comparison of short- and midterm outcomes in patients following ream-and-run and anatomic total shoulder arthroplasties

BACKGROUND

Anatomic total shoulder arthroplasty (aTSA) may not be an ideal treatment option for young and active patients because of potential activity restriction and concerns about glenoid loosening. The ream-and-run procedure (RnR) allows for the continuance of high-level activity without concerns of a glenoid component failure. Initial RnR publications are promising, although more outcomes studies are needed. Therefore, our primary purpose was to compare outcomes at multiple time points between matched aTSA and RnR cohorts. Second, we sought to examine relationships between patient-reported outcomes and preoperative glenoid pathoanatomy in our RnR cohort Last, we examined postoperative radiographs to determine if the RnR successfully corrected glenoid pathoanatomy and humeral head decentering.

METHODS

We performed a retrospective matched-cohort study comparing patients who underwent an RnR vs. patients who underwent the aTSA procedure between 2017 and 2019. All patients had primary diagnoses of shoulder osteoarthritis and a minimum of 2-year follow-up. Simple Shoulder Test, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), and daily and worst pain outcomes were compared between groups at 3 and 6 months, and 1 and 2 years postarthroplasty. Pre- and postoperative glenoid anatomy and humeral decentering were measured radiographically, and correlation analyses were conducted to explore relationships between these factors and 2-year pain and function scores.

RESULTS

Forty-six shoulders (23 RnR and 23aTSA) belonging to 43 male patients with an average age of 56.2 ± 8.3 years were included. Eighteen matched pairs were available at 3 and 6 months, 21 matched pairs at 1 year, and all 23 matched pairs at the 2-year time point. RnR patients reported significantly higher daily pain ratings (P = .047) and lower ASES scores (P = .031) compared with the aTSA group 3 months after arthroplasty but reported similar outcomes at 6 months and beyond. Preoperative pathoanatomy outcomes were not directly related to final reported pain or function in the RnR group. Additionally, the RnR was able to correct posterior humeral head decentering in our cohort.

CONCLUSIONS

Young male patients undergoing RnR can likely expect similar short-term results as young male patients who undergo aTSA. Additionally, the RnR outcomes were not affected by preoperative glenoid wear or humeral head decentering. Our findings support the RnR as a viable surgical alternative for young, active patients with shoulder arthritis.

Shoulder Hemiarthroplasty with Nonprosthetic Glenoid Arthroplasty: The Ream-and-Run Procedure

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Glenoid component wear and loosening are the principal failure modes of anatomic total shoulder arthroplasty (aTSA).

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The ream-and-run (RnR) procedure is an alternative glenohumeral arthroplasty for patients who wish to avoid the risks and limitations of a prosthetic glenoid component.

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During the RnR procedure, the arthritic glenoid is conservatively reamed to a single concavity, while the prosthetic humeral component and soft tissues are balanced to provide both mobility and stability of the joint.

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The success of the RnR procedure depends on careful patient selection, preoperative education and engagement, optimal surgical technique, targeted rehabilitation, and close postoperative communication between the surgeon and the patient.

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While the RnR procedure allows high levels of shoulder function in most patients, the recovery can be longer and more arduous than with aTSA.

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Patients who have undergone an RnR procedure occasionally require a second closed or open procedure to address refractory shoulder stiffness, infection, or persistent glenoid-sided pain. These second procedures are more common after the RnR than with aTSA.

Functional Outcomes of the Ream-and-Run Shoulder Arthroplasty: A Concise Follow-up of a Previous Report

We previously reported the results at an average of 4.5 years after treatment of 176 patients with the ream-and-run arthroplasty. In the present study, we present the patient self-reported functional outcomes and clinical implant survival of the original cohort at a mean of 10 years (range, 5 to 16 years). Twenty-eight (16%) of the 176 patients had a subsequent procedure, 11 (6%) died, and 30 (17%) had <5 years of follow-up. The Simple Shoulder Test (SST) score at the time of the latest follow-up was a median of 11 points (interquartile range, 9 to 12 points) and a mean (and standard deviation) of 10 ± 2.6 points, out of a possible 12 points. The present study demonstrates that the improvement in function and comfort derived from the ream-and-run procedure can be sustained at the time of mid-term follow-up.

LEVEL OF EVIDENCE

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Clinical and Radiographic Outcomes of the Ream-and-Run Procedure for Primary Glenohumeral Arthritis

BACKGROUND

The ream-and-run procedure can provide improvement in shoulder function and comfort for selected patients with primary glenohumeral arthritis who wish to avoid a prosthetic glenoid component. The purpose of this study was to evaluate factors associated with medialization of the humeral head after this procedure as well as the relationship of medialization to the clinical outcome.

METHODS

We collected patient, shoulder, and procedure characteristics along with Simple Shoulder Test (SST) scores before surgery and at the time of follow-up. Medialization was determined by comparing the position of the humeral head prosthesis in relation to the scapula on postoperative baseline radiographs made within 6 weeks after surgery with that on comparable follow-up radiographs made ≥18 months after surgery.

RESULTS

Two-year clinical outcomes were available for 101 patients (95% were male). Comparable radiographs at postoperative baseline and follow-up evaluations were available for 50 shoulders. For all patients, the mean SST score (and standard deviation) increased from 4.9 ± 2.8 preoperatively to 10.3 ± 2.4 at the latest follow-up (p < 0.001). Significant clinical improvement was observed for glenoid types A2 and B2. Shoulders with a type-A2 glenoid morphology, with larger preoperative scapular body-glenoid angles, and with lower preoperative SST scores, were associated with the greatest clinical improvement. Clinical outcome was not significantly associated with the amount of medialization.

CONCLUSIONS

The ream-and-run procedure can be an effective treatment for advanced primary glenohumeral osteoarthritis in active patients. Further study will be necessary to determine whether medialization affects the clinical outcome with follow-up of >2 years.

LEVEL OF EVIDENCE

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Biologic resurfacing of the glenoid with meniscal allograft: long-term results with minimum 2-year follow-up

BACKGROUND

There is a lack of consensus in treating glenohumeral arthritis in younger patients. Hemiarthroplasty has historically been favored because of complications associated with total shoulder arthroplasty. Biologic resurfacing of the glenoid has been investigated as a potential treatment that would decrease glenoid erosion and pain, the major complications of hemiarthroplasty.

MATERIALS AND METHODS

We report on 19 shoulders treated with meniscal allograft glenoid resurfacing and shoulder hemiarthroplasty. All patients were followed up for a minimum of 2 years postoperatively (mean, 4.25 years) with Disabilities of the Arm, Shoulder and Hand (DASH), Simple Shoulder Test (SST), and visual analog scale (VAS) scores. In addition, we compared the outcomes related to preoperative concentric versus eccentric glenoid wear.

RESULTS

At final follow-up, the mean score for the DASH questionnaire was 28; SST, 8; and VAS, 3.5. Whereas the eccentric wear group (DASH score, 19.4; SST score, 9.1; VAS score, 2.5) exhibited better shoulder function and pain scores compared with the concentric wear group (DASH score, 37.6; SST score, 8.4; VAS score, 4.1), the difference was not statistically significant (P = .098, P = .647, and P = .198, respectively). There were 6 complications (32%), all resulting in repeat surgery. Three patients underwent total shoulder arthroplasty and one shoulder had revision hemiarthroplasty, whereas synovectomy was performed in another shoulder. The sixth patient underwent lysis of adhesions and capsular release.

DISCUSSION

With long-term follow-up, we have observed that biologic resurfacing of the glenoid with meniscal allograft exhibits inconsistent results and high complication rates. Strong consideration should be given to performing total shoulder arthroplasty in patients in whom all conservative treatment options have failed.

The prognosis for improvement in comfort and function after the ream-and-run arthroplasty for glenohumeral arthritis: an analysis of 176 consecutive cases

BACKGROUND

Knowledge of the factors affecting the prognosis for improvement in function and comfort with time after shoulder arthroplasty is important to clinical decision-making. This study sought to identify some of these factors in 176 consecutive patients undergoing the ream-and-run procedure.

METHODS

The time course for improvement in patient function and comfort was determined for the entire group as well as for subsets by sex, age, diagnosis, preoperative function, and surgery date. Patients having repeat surgery were analyzed in detail.

RESULTS

Shoulder comfort and function increased progressively after the ream-and-run procedure, reaching a steady state by approximately twenty months. The shoulders in 124 patients with at least two years of follow-up were improved by a minimal clinically important difference. The shoulders in sixteen patients with at least two years of follow-up were not improved by the minimal clinically important difference. Twenty-two patients had repeat procedures, but only seven had revision to a total shoulder arthroplasty. Fourteen patients did not have either a known revision arthroplasty or two years of follow-up. The best prognosis was for male patients over the age of sixty years, with primary osteoarthritis, no prior surgical procedures, a preoperative score on the simple shoulder test of ≥5 points, and surgery after 2004. Repeat surgical procedures were more common in patients who had a greater number of surgical procedures before the ream-and-run surgery.

CONCLUSIONS

This study is unique in that it characterizes the factors affecting the time course for improvement in shoulder comfort and function after a ream-and-run procedure. Improvement occurs after this procedure for at least 1.5 years. This procedure appears to be best suited for an older male patient with reasonable preoperative shoulder function without prior shoulder surgery.

LEVEL OF EVIDENCE

Prognostic Level II. See Instructions for authors for a complete description of levels of evidence.

Shoulder hemiarthroplasty with concentric glenoid reaming in patients 55 years old or less

BACKGROUND

Glenohumeral arthritis in younger individuals is challenging because of the complex pathology, need for extended durability, and high expectations of the patients. Humeral hemiarthroplasty combined with concentric glenoid reaming is a surgical option for the management of glenohumeral arthritis that avoids the risks of glenoid component failure and avoids the challenges of tissue interposition. The results of this procedure in young patients have not been previously reported.

METHODS

Sixty-five shoulders in patients who were 55 years old or less at the time of surgery underwent humeral hemiarthroplasty combined with concentric glenoid reaming and were followed for a minimum of 2 years or until the time of revision surgery. Patient self-assessments of shoulder comfort and function were compared before and after surgery. For 22 of these shoulders, standardized radiographs were available for follow-up evaluation.

RESULTS

Nine shoulders required revision surgery. These shoulders had 3 ± 3 prior surgeries, in comparison to 1 ± 1 prior surgeries for the unrevised group. For the 56 unrevised shoulders, the number of Simple Shoulder Test functions that could be performed improved from a mean of 4.1 before surgery to a mean of 9.5 at an average follow-up of 43 months (range, 24-85) (P < .001). For the 22 shoulders with radiographic follow-up, medial glenoid erosion averaged 1.1 mm (range, 0.0-6.3 mm) at an average of 44 months after the procedure.

CONCLUSION

In selected patients 55 years or younger with glenohumeral arthritis, this procedure can provide significant improvement in self-assessed shoulder comfort and function.

A quantitative method for determining medial migration of the humeral head after shoulder arthroplasty: preliminary results in assessing glenoid wear at a minimum of two years after hemiarthroplasty with concentric glenoid reaming

HYPOTHESIS

Glenoid erosion and medial migration of the humeral head prosthesis have been observed after most types of shoulder arthroplasty. A method of measuring the change in humeral head position with time after shoulder prosthetic arthroplasty was applied it to 14 shoulders that underwent humeral hemiarthroplasty with concentric glenoid reaming. We hypothesized that the measurement technique would be reproducible and that the rate of wear would be small in the series of shoulders studied.

MATERIALS AND METHODS

Standardized anteroposterior and axillary radiographs were obtained after surgery. Two examiners measured the position of the humeral head center in relation to scapular reference coordinates for the anteroposterior and axillary projections and plotted these values against time after surgery. The change in position was characterized as the slope of this plot. Shoulders were included if there were at least 3 sets of postoperative films, the last being at least 2 years after surgery.

RESULTS

The slopes measured by the 2 examiners agreed within 0.5 mm/y for the anteroposterior and the axillary projections. For the series of shoulder arthroplasties, the rate of movement of the head center toward the scapula was less than 0.4 mm/y for either examiner in either projection.

DISCUSSION

Medial migration is a concern after any type of shoulder arthroplasty, whether a hemiarthroplasty, a biological interpositional arthroplasty, or a total shoulder arthroplasty. Quantifying the rate of medial migration over time after shoulder arthroplasty is an important element of clinical follow-up.

CONCLUSIONS

This is an inexpensive, practical, and reproducible method that can be used to determine the rate of medial migration of the humeral head on plain radiographs after shoulder arthroplasty. The average rate of medial migration in the shoulders in this study was small.